DENVER II

The DENVER II (1992) is a revision and update of the Denver Developmental Screening Test, DDST (1967).^[1][2] Both were designed for use by the clinician, teacher, or other early childhood professional to monitor the development of infants and preschool-aged children. Doing so, enables the clinician to identify children whose development deviates significantly from that of other children warranting further investigation to determine if there exists a problem requiring treatment. The tests cover four general functions: personal social (such as smiling), fine motor adaptive (such as grasping and drawing), language (such as combining words), and gross motor (such as walking). Ages covered by the tests range from birth to six years. Since its publication the test has enjoyed widespread popularity as reflected by its use in many of this nation’s medical schools.

The DENVER II, published in 1992, was standardized on 2,096 children. Its interpretation was slightly modified from the DDST giving greater emphasis to a comparison of the child’s performance on each item with the new norms, much as clinicians have compared children’s growth on individual parameters as height, weight and head circumference to ascertain a child’s health status.

There are five unique features of the test that generally differentiates it from most other developmental screening tests:

1. Its validity rests upon its meticulous and careful standardization reflecting the US 1980 census population.^[3] Most other developmental screening tests base their validity on measures of sensitivity and specificity. Most such studies suffer from one or more of the following: small sample size, verification bias, inappropriate/non- equivalent test bias, procedural bias, spectrum bias and incomplete reporting of results.^[4][5][6]
2. Since the test depicts in graphic form the ages at which 25%, 50%, 75% and 90% of children performed each item, it enables the examiner to visualize at any age from birth to six years how a given child’s development compares with that of other children.
3. The test has separate norms for subgroups of the population based on sex, ethnicity and maternal education when the subgroups differed by a clinically significant amount from the total group or composite norms.
4. The test is primarily based upon an examiner’s actual observation rather than parental report.
5. It is ideal for visualizing on one page the developmental progress of children whether or not their development is being monitored for well child care or because the child’s development is of special concern.

The above unique features of the test as well as its ease of administration and interpretation contribute to its widespread use in screening programs as public child health clinics, private practices, early education programs such as Parents as Teachers, nursery schools and day care centers. In fact, the DDST and the DENVER II test have been translated into numerous foreign languages, as well as re-standardized on over 1,000 children in each of 12 countries to obtain national norms, resulting in its use to screen millions of children throughout the world.

Most recently the American Academy of Pediatrics Council on Children with Disabilities; Section on Developmental Behavioral Pediatrics published a list of screening tests for clinicians to consider when selecting a test to use in their practice. This list includes the DENVER II among its choices.^[7]

References

1. ^ Frankenburg, W.K. and Dodds, J.B.: The Denver Developmental Screening Test. J. Pediat., 71:181, 1967.
2. ^ Frankenburg, W.K., Dodds, J., Archer, P. et al.: The DENVER II: A major revision and restandardization of the Denver Developmental Screening Test. Pediatrics, 89:91-97, 1992.
3. ^ Frankenburg, W.K., Dodds, J., Archer, P. et al.: The DENVER II Technical Manual 1990, Denver Developmental Materials, Denver, Co.
4. ^ Camp, B.W.: Evaluating bias in validity studies of developmental/ behavioral screening tests, 2007,28,234-240.
5. ^ Begg, C.B.Biases in the assessment of diagnostic tests. Stat Med 1987;6:411-423
6. ^ Altman, D.G.: Some common problems in medical research. Practical statistics for medical research. New York, N.Y; Chapman and Hall; 1991:396-438
7. ^ American Academy of Pediatrics, Council on Children with Disabilities; Section on Developmental Behavioral Pediatrics; Bright Futures Steering Committee; Medical Home Initiatives for Children with Special Needs Project Advisory Committee. Identifying infants and young children with developmental disorders in the medical home: an algorithm for developmental surveillance and screening. Pediatrics, 2006;118:405-420